Cardiac abnormalities in acromegaly. Pathophysiology and implications for management

Area of Science:

• Cardiology
• Endocrinology
• Internal Medicine

Background:

• Cardiovascular disease is a major cause of mortality in acromegaly.
• Excess growth hormone (GH) and insulin-like growth factor 1 (IGF-I) disrupt cardiomyocyte function, causing specific cardiomyopathy.
• Acromegalic cardiomyopathy presents with hyperkinetic syndrome, concentric hypertrophy, diastolic dysfunction, and potentially systolic dysfunction and heart failure.

Purpose of the Study:

• To review the cardiac manifestations of acromegaly.
• To discuss the impact of GH/IGF-I excess on cardiac structure and function.
• To emphasize the importance of early diagnosis and treatment for reversing cardiac damage.

Main Methods:

• Review of existing literature on acromegaly and cardiovascular complications.
• Analysis of the pathophysiology linking GH/IGF-I excess to cardiac abnormalities.
• Discussion of treatment outcomes on cardiac parameters.

Main Results:

• Concentric hypertrophy is found in over two-thirds of acromegaly patients at diagnosis.
• Diastolic dysfunction is common, progressing to systolic dysfunction and heart failure if untreated.
• Successful acromegaly treatment improves left ventricular mass and diastolic function; systolic function effects are variable.
• Cardiovascular alterations are milder in younger patients with shorter disease duration, suggesting easier reversal.

Conclusions:

• Acromegalic cardiomyopathy requires careful cardiac assessment, including function, morphology, and activity.
• Early diagnosis and effective treatment are crucial for reversing or halting the progression of acromegalic cardiomyopathy.
• Prompt management can mitigate severe cardiovascular outcomes in acromegaly patients.